Oncologic Emergencies

Oncologic Emergencies Neoplasm = new and abnormal formation of tissue (tumor) Benign tumor = Does not spread by infilatration of tissue Malignant tumor (cancer) = Spreads from primary to distant sites (metastasis) Destroys host tissues

Oncologic Emergencies Benign Tumors Structure typical of tissue of origin Slow rate of growth Mostly encapsulated Slightly vascularlized Does not metastasize Necrosis, ulceration unusual Rarely recurs after removal

Oncologic Emergencies Malignant Tumors Structure atypical of tissue of origin Rapid rate of growth Loosely or not encapsulated Moderately to highly vascularlized Metastasizes Necrosis, ulceration common Frequently recurs after removal

Oncologic Emergencies Types of malignant tumors Epithelial tissues = Carcinomas Melanocytes of skin = Melanomas Connective tissues = Sarcomas Lymphatic tissues = Lymphomas Glial tissues of CNS = Neurogliomas Granular leukocytes = Leukemias Plasma cells = Multiple myeloma

Oncologic Emergencies Consequences of tumor growth Destruction of invaded tissue Obstruction of organs Compression of adjacent structures Abnormal hormone production Nutritional deficiencies, starvation Hemorrhage Infection

Upper Airway Obstruction Late result of tumors of Oropharynx Neck Superior mediastinum

Upper Airway Obstruction Suspect in afebrile patients with Stridor Palpable neck masses History of voice change

Upper Airway Obstruction Acute compromise may be caused by: Infection Hemorrhage Trapped secretions Remove or bypass obstruction

Upper Airway Obstruction Management Remove or bypass obstruction Suction Endotracheal intubation Surgical airway

Laryngectomy Patient Patient breathes through stoma at base of neck May be complete or partial

Laryngectomy Patient Ventilate through opening in midline at base of neck Ignore other openings Seal mouth/nose in partial laryngectomy

Acute Spinal Cord Compression Compression from: Tumor Collapse of vertebrae Hemorrhage Infection

Acute Spinal Cord Compression Suspect if patient with malignancy develops: Paraparesis Paraplegia Sensory deficits Urinary incontinence Acute urinary retention

Acute Spinal Cord Compression Focal or nerve root pain may occur Pain localized to involved vertebrae may be present

Acute Spinal Cord Compression Management Immobilize spine Steroids Emergency surgical decompression or radiotherapy indicated

Pericardial Effusion Causes Effusion from pericardial metastasis Secondary hemorrhage Infection Chemotherapeutic agents Radiation-induced pericarditis

Pericardial Effusion Effects depend on volume, speed of fluid accumulation

Pericardial Effusion Signs Resistant hypotension Narrow pulse pressure Jugular vein distension Diminished heart sounds Pulsus paradoxus

Pericardial Effusion Emergency pericardiocentesis may be needed

Superior Vena Cava Syndrome Cause Obstruction of superior vena cava Increased venous pressure in Arms Neck Face Cerebrum

Superior Vena Cava Syndrome Signs and Symptoms Headache Syncope Feeling of head congestion and fullness in neck/face Edema of face/arms Neck/upper chest vein distension Facial plethora Telangiectasia

Superior Vena Cava Syndrome May produce Increased intracranial pressure Decreased preload and cardiac output

Superior Vena Cava Syndrome Management Lasix Steroids

Hemorrhage Causes Erosion of vessel walls by neoplasm Therapy-induced coagulation problems Thrombocytopenia

Hemorrhage Management Control hemorrhage with standard techniques Treat hypovolemia

Chemotherapy Agent Release Can result from malfunction of ambulatory chemotherapy units Highly toxic Wash off skin immediately Report exposure to physician

Vascular Access Do not start IV’s in implants or shunts used for chemotherapy Implants may lead to areas other than vascular system Needles may damage implant or shunt